Is Ultrasound a Useful Tool to Predict Severe Dengue Infection?

Abstract

Objectives: To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease.

Methods: This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry.

Results: Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4 % respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4 %) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge.

Conclusions: Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.

Keywords: Ascites; Gall bladder wall thickening; Plasma leakage; Pleural effusion; Severe dengue; Ultrasound.